| NPI | 1992286520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 125769) |
| Additional Taxonomies | 104100000X Social Worker |
| 101YM0800X Counselor, Mental Health | |
| 172V00000X Community Health Worker (Licence: CA 92604) | |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2024-11-29 |